Pediatrics
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Sepsis is defined as the systemic inflammatory response of the human host that is triggered by an invading pathogen. Despite tremendous advances in both our knowledge of and treatment strategies for this syndrome, sepsis remains among the major causes of morbidity and mortality in children worldwide. ⋯ As a result, given the central importance of the alterations in gene expression in regulating the human host's physiologic response to a pathogen, we review the complex factors-genetics, transcriptional expression, and epigenetics-that regulate unique gene-expression patterns in pediatric sepsis and septic shock. We anticipate that emerging data from genetic, genomic, and other translation studies in pediatric sepsis will advance our biological understanding of this response and undoubtedly identify targets for newer therapies.
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The goal was to examine nursing team structure and its relationship with family satisfaction. ⋯ Family perceptions of nursing care quality are more strongly associated with team structure and the sequence of nursing participation than with team size. Objective measures of health care team structure and function can be examined by applying network analytic techniques to information contained in electronic health records.
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We describe children's postconcussive symptoms (PCSs), neurocognitive function, and recovery during 4 to 5 weeks after mild traumatic brain injury (MTBI) and compare performance and recovery with those of injured control group participants without MTBIs. ⋯ In children 10 to 17 years of age, self-reported PCSs were not exclusive to patients with MTBIs. However, PCSs and recovery patterns for the Trail-Making Test Part B differed significantly between the groups.
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Neonatal resuscitation guidelines recommend techniques to minimize heat loss in the delivery room. The use of humidified and heated gas is standard of care for preterm infants who need respiratory support in the NICU, but international resuscitation guidelines do not stipulate use of this therapy during stabilization at birth. We aimed to investigate the effect of humidified and heated gas on admission temperature in preterm infants who require respiratory support at birth. ⋯ The use of heated and humidified air during respiratory support in very preterm infants just after birth reduced the postnatal decrease in temperature. Heating and humidifying the gas during stabilization merits additional investigation.
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Comparative Study
Variation in pediatric and adolescent firearm mortality rates in rural and urban US counties.
We examined whether firearm mortality rates among children varied across US counties along a rural-urban continuum. ⋯ Children in the most-rural US counties had firearm mortality rates that were statistically indistinguishable from those for children in the most-urban counties. This finding reflects a greater homicide rate in urban counties counterbalanced by greater suicide and unintentional firearm death rates in rural counties. Nonfirearm mortality rates were significantly greater outside the most-urban US counties.